The present invention relates to a suturing device used with an endoscope for suturing a tissue or stanching blood in a body cavity.
Endoscopic suturing devices are described, for example, in U.S. Pat. No. 5,037,433, or U.S. Pat. No. 3,168,097, both herein incorporated by reference. Recently, improved endoscopic treatment procedures have developed. Medical treatment may be received without major surgery, such as abdominal section treatment. Because suturing of tissue or stanching of blood after penetration in a body cavity is important, efforts have been made to develop endoscopic techniques.
For example, U.S. Pat. No. 5,037,433 describes a method in which an elongated flexible outer tubular endoscope member has multiple flexible lumens. A flexible endoscope is arranged in one of the lumens. An inner tubular member is arranged in another lumens. A forceps device with forceps in a flexible body portion is arranged in one of the remaining lumens. A curved needle is bent and inserted into the inner tubular member in a slightly stretched state. In addition, the curved needle has a suture member on its proximal end side. For suturing, the curved needle is pushed out from the inner tubular member by pushing the rod members arranged on the distal end of the inner tube, and at the same time, the restoring force is utilized to suture a wound in a body cavity.
U.S. Pat. No. 3,168,097 describes a needle holder used at the time of suturing in a surgical operation. The ""097 patent describes a curved needle equipped with a suture at the proximal end that is set in a needle grasping member positioned at the tip of the needle holder. A flexible cable is wound once on the outer circumference of a small coaxial pulley that is fixed to the needle grasping member end. The flexible cable is connected with sleeve through a short rod. The other end is fixed with a turn spring through a short rod, and by maneuvering the curved needle, a lever fixed with a sleeve sutures the wounds in the body while rotating.
Because the device disclosed in ""433 patent uses an elastic curved needle inserted in a thin inner tube in a straightly stretched state, the curved needle cannot penetrate deeply into the tissue. The penetrating force is reduced by resistance to the inner tube and the curved needle. The resistance is caused by the restoring power of the curved needle as the curved needle is pushed out from the inner tube by the rod member. In addition, the flexible outer tubular endoscope member may not be bent sufficiently because the rod member has a certain rigidity to push the curved needle from the inner tube. Because the curved needle may not be pressed into the inner tube once the curved needle penetrates the tissue, adjustment may not be made if the curved needle is off target. Moreover, a greater diameter of the flexible outer tubular endoscope member may increase the pain of the patient due to its multi-lumen structure including an endoscope, suturing member, and forceps device.
The ""097 patent describes a needle holder originally developed for a surgical operations not suitable for a flexible endoscope. Further, a flexible cable that works the pulley is not firmly fixed to the pulley. Thus, the pulley and the flexible cable slip off when a needle penetrates tissue, and result in a driving force that is not transferred to the needle. After a needle penetrates the body tissue, a lever is released and the righting moment of a spring puts the needle back to the original position. The driving force comes from the spring""s flexibility and is insufficient for removing the needle from the body tissue. Moreover, the needle is subject to a force by a spring for the opposite side of the direction of penetration that will decrease the penetrating force when the tissue is penetrated. This effect may result in the body tissue is not being penetrated effectively.
The present invention offers an endoscopic suturing device that solves the above problems using a flexible endoscope. The effective transfer of the penetrating force occurs despite various bending positions of the endoscope and the adjustment of penetration positions. A smaller outer diameter of the device provides easier maneuvering of the endoscope for suturing. This allows a suturing device to approach the target point of the body tissue easier by maneuvering an endoscope angulation.
The endoscopic suturing device includes a suturing device having a curved needle to suture tissue. The endoscopic suturing device also includes a driving means to maneuver the curved needle. The curved needle and the driving means are placed at a distal end of the endoscopic suturing device. A flexible endoscope is connected to the suturing device.
According to an embodiment of the present invention, an endoscopic suturing device lets a suture pass through a suturing suture hole positioned near the end of a curved needle. The device inserts a grasping forceps via a forceps channel of an endoscope and brings the suture into the proximal end of the endoscope via the forceps channel. At this time, the proximal end of a suturing device will also be inserted from the distal end of a forceps channel into the flexible endoscope. Further, a protective member is arranged at the distal end of the flexible endoscope so that the curved needle of the suturing device will not injure the human body when the suturing device is inserted into a body cavity.
The endoscopic suturing device also inserts into a suture point in the body cavity a suturing device that has been set into an endoscope.
The device maneuvers the rotating maneuvering member of the curved needle, rotates the needle and penetrates the curved needle into the suturing point. Via another channel of an endoscope or an outer channel, the device uses a suture-grasping member to hold and bring an end of the suture protruding from the tissue to the proximal end. The device forms a knot by the two withdrawn sutures and uses a knot pusher to push the knot to the point of a suturing position via the said channel of an endoscope or outer channel and repeat the suturing operation for several times.